小切口自体髂骨骨松质修复牙槽嵴裂及口鼻瘘的临床研究

目的：分析小切口自体髂骨骨松质修复牙槽嵴裂的手术方法及影响植骨成功的因素。方法：对同一术者所行牙槽嵴裂植骨术的唇腭裂患者22例进行临床研究，所有患者均有术前及术后6个月以上的完整资料。探讨植骨区X线影像的临床分级与手术年龄、手术类型、裂隙类型类型等的关系。结果：植入骨成活率95.8％，临床成功率为91.7％；（2）18岁以上年龄组、完全性唇腭裂组、双侧唇腭裂组患者植骨的临床成功率相对较低；（3）本组病例均采用小切口，以骨移植用圆筒形取骨器切取髂骨骨松质，局部创伤小，术后疼痛轻。结论：以骨移植用圆筒形取骨器通过小切口自体髂骨骨松质是进行牙槽嵴裂植骨的一种良好方法。（2）良好植骨床的形成和植骨区无张力的严密缝合是保证牙槽嵴裂植骨成功的关键；植骨时机是植骨成功是否的重要因素；（3）牙槽嵴裂的植骨效果与手术年龄、裂隙类型、裂侧类型等有关。     

异种脱细胞真皮基质用于牙槽嵴裂植骨术的效果观察

目的探讨在牙槽嵴裂植骨术中应用脱细胞真皮基质能否提高完全性唇腭裂患者植骨术后效果。方法对63例完全性唇腭裂患者共72侧裂隙以自体髂骨松质骨行牙槽嵴裂植骨术,术中同时应用脱细胞真皮基质。术后至少3个月时按照Bergland标准评价其上颌前部咬合片,统计临床成功型所占的比例,并与按相同手术方法植骨但未应用脱细胞真皮基质的植骨效果进行比较。结果脱细胞真皮基质组的临床成功率为75%,高于对照组(51%)。其中单侧牙槽嵴裂组53侧裂隙的成功率为81%,高于对照组(56%);双侧牙槽嵴裂组19侧裂隙的临床成功率为58%,与对照组(42%)无显著性差异。结论完全性唇腭裂患者在牙槽嵴裂植骨术中应用脱细胞真皮基质可以提高手术效果。     

髂骨松质骨移植修复牙槽嵴裂21例临床分析

目的:分析影响牙槽嵴裂修复术后效果的因素.方法:对2003-2007年收治的21例牙槽嵴裂患者,采用髂骨松质骨移植修复,术后随访3～12个月,拍摄X线片,分析患者年龄、裂隙类型、手术方法以及植骨来源对手术效果的影响.结果:①手术成功率为95.24%.临床成功率为90.48%;②植骨效果与植骨年龄有关;③单侧牙槽嵴裂手术成功率优于双侧牙槽嵴裂.结论:①手术年龄以9～11岁尖牙萌出前较为合适,年龄越小,植骨成功的可能性越大;②髂骨是良好的供骨源;③良好的植骨床形成、创口的无张力严密缝合是手术成功的关键.     

唇腭裂患者齿槽嵴裂植骨修复术后随访结果分析

目的分析影响齿槽嵴裂修复术后效果的因素。方法对同一术者所行齿槽嵴裂植骨术的唇腭裂患者５４例进行回顾性研究，所有患者均有术前及手术后３个月以上的完整资料。分析植骨区的Ｘ线组织影像的临床分级与手术年龄、裂类型及手术类型等的关系。结果①齿槽嵴裂的植入骨成活率为９４％，临床成功率为８９％；②齿槽嵴裂的植骨效果与患者的年龄有关，１８岁以上患者植骨的临床成功率明显低于其他年龄患者；③除腭瘘修补术外，齿槽嵴裂植骨术与其他唇腭裂手术同期完成者其临床成功率与单纯行齿槽嵴裂植骨术的临床成功率相似；④单纯伴发唇裂或不完全腭裂的齿槽嵴裂植骨效果优于完全性唇腭裂的齿槽嵴裂植骨效果。结论良好植骨床的形成和植骨区严密的缝合是保证齿槽嵴裂植骨成功的关键     

牙槽突裂的裂隙特点及正畸治疗对唇腭裂患者牙槽突植骨术的影响

牙槽突裂是位于唇腭裂患者上颌牙弓处的骨缺损,常发生于侧切牙与尖牙之间。由于先天性裂隙、早期手术治疗所致瘢痕挛缩及唇肌压迫等原因,患者多并发严重的上颌骨横向发育障碍。牙槽突植骨术作为唇腭裂序列治疗中的重要步骤,是修补上颌骨裂隙和矫正上颌横向发育不足的有效手段。众多临床实践及研究发现,正畸治疗的时机选择与牙槽突植骨术的成功率及预后效果密不可分,同时,牙槽突裂的裂隙特点对牙槽突植骨术产生的影响也不可忽视。本文就牙槽突裂的裂隙特点与正畸治疗时机对牙槽突植骨术成功率及预后的影响两方面进行综述,以期为唇腭裂患者临床治疗方案的选择及实验研究的设计提供一定的依据。     

唇、腭侧联合入路修复牙槽突裂的临床初步研究

目的：探讨唇、腭侧联合入路修复牙槽突裂的临床效果。方法45例先天性牙槽突裂患者接受植骨手术修复,其中21例（年龄9~13岁,平均年龄10.3岁）行唇、腭侧联合入路植骨修复（实验组）,24例（年龄9~14岁,平均年龄11.2岁）行唇侧入路植骨修复（对照组）。术后1~12个月随访,采用临床回顾性研究的方法比较2组术后疼痛、肿胀程度;牙槽突裂植骨成功率评价的临床分级标准一般以Bergland牙槽突裂植骨分级标准进行评价。结果实验组在术后疼痛、肿胀程度均低于对照组;实验组植骨手术成功率81%,对照组植骨手术成功率42%。结论唇、腭侧联合入路植骨修复牙槽突裂手术创伤小、术后不良反应少,临床效果满意。     

唇腭裂二期牙槽突植骨二维与三维影像评价方法的对比分析

目的　探讨二维X线片与CT扫描及三维重建在评价唇腭裂二期牙槽突植骨疗效中的一致性。方法　选择唇腭裂二期牙槽突植骨术后半年以上的唇腭裂 9例 (单侧完全性唇腭裂 8例 ,双侧完全性唇腭裂 1例 ) ,牙槽突裂隙为 10侧。年龄范围 12～ 2 6岁 ,平均年龄 15 5岁。患者首先拍摄上颌前部咬合片 ,经Bergland分级标准确定为 :Ⅰ型 :2侧 ;Ⅱ型 :2侧 ;Ⅲ型 :5侧 ;Ⅳ型 :1侧。在上颌前部咬合片拍摄后的 2个月内 ,进行上颌骨CT扫描及三维重建。结果　上颌前部咬合片所示裂隙植骨区牙槽骨的高度被CT证实。CT检查发现有 2个裂隙植骨区存在唇、腭侧凹陷。结论　唇腭裂牙槽突植骨后 ,在正畸前仍然可以使用上颌前部咬合片进行牙槽突植骨疗效的评价。但同时应注意观察X线片植骨区牙槽骨的密度和临床检查 ,必要时应该进行CT检查     

自体髂骨移植修复犬牙槽突裂的实验研究

目的:建立与临床牙槽突裂自体髂骨移植相似的Beagle犬动物模型,为临床唇腭裂序列治疗提供实验对象,适用于牙槽突裂植骨后的评价和相关研究。方法:7只24周龄Beagle犬,用外科手术方法制备上颌单侧牙槽突裂,再即刻植入自体髂骨建立动物模型,术后即刻及术后4、8、12周进行X线片检查和术后12周行组织学观察对其进行评价。1只犬仅制备牙槽突裂,不植骨作为空白对照。结果:所有实验组动物形成规则的牙槽突裂隙植骨区,裂隙两侧的牙齿未受损伤。术后12周,空白对照犬的牙槽突裂隙区无新骨形成。结论:该牙槽突裂即刻植骨动物模型与临床情况相似,重复性、稳定性好,可模拟临床进行相关实验研究。     

骨移植术在修复腭裂牙槽突裂畸形中的应用

为探讨骨移植术在修复腭裂牙槽突裂中的意义，以便更好地指导临床，作者对１１０例行植骨术的病例进行了初步总结分析，在手术的适应症、技术方法、效果评价、供骨区选择及术前、后处理等问题上进行探讨。结果表明：骨移植修复牙槽突裂是一种可推广的手术；术区的严密关闭是植骨成功的关键；植骨术前、后应接受正畸治疗；供骨区的选择应根据患者年龄、牙龄、裂隙大小及需骨量等综合因素来决定。     

98例唇腭裂患者牙颌面畸形的正畸-正颌外科联合治疗分析

目的 评价正畸-正颌外科联合治疗唇腭裂伴牙颌畸形的效果。方法 回顾分析1990年1月-2000年6月期间在上海第二医科大学和香港大学口腔颌面外科收治的98例唇腭裂伴牙颌面畸形患者，男性52例，女性46例，年龄16—40岁，平均年龄20．5岁。所有患者均在手术前完成正畸治疗，排齐牙列，关闭间隙等。上颌骨手术采用标准化截骨前移手术，伴牙槽裂的患者同期行髂骨取骨植骨术。手术方法包括：①牙槽裂已植骨修复者。采用标准Le fortⅠ型截骨前移术；②牙槽裂未植骨修复的单侧腭裂患者，采用改良上颌骨截骨手术，即非裂侧用Le Fort Ⅰ型截骨术,裂隙侧采用牙槽骨截骨手术(Schuchardt法)，同期行牙槽裂植骨术；③牙槽裂未植骨修复的双侧腭裂患者，采用前颌骨截骨手术(Wunderer法)和双侧上颌骨后份牙槽骨截骨手术(Schuchardt法)，同期行牙槽裂植骨修复术。骨间采用小钛板坚强内固定。随访时间1／2—5a。平均2．6a。结果 术后患者的面型均取得了明显的改善，面部比例协调，咬合关系相对稳定。结论 正畸-正颌外科联合治疗唇腭裂伴牙颌面畸形的效果稳定，应该作为这类畸形治疗的常规方法。     

两类单侧不全唇裂鼻畸形临床特点的初步研究

目的：研究单侧不全唇裂伴有／和不伴有牙槽突裂患儿的唇、鼻部畸形特征。方法：对68例患者进行唇鼻部相关数据的测量研究,采用改良Mohler术式修复唇裂并同期矫正鼻畸形。结果：术前测量显示伴有牙槽突裂患儿的唇峰～鼻翼,唇峰～鼻小柱基底的距离,鼻孔高,鼻孔宽和鼻小柱高度与不伴有牙槽突裂的患儿相同指标有显著性差异。结论：通过测量数据的分析显示：单侧不完全性唇裂伴有牙槽突裂是一种畸形更为严重的不全唇裂。     

双侧唇裂术后复裂的因素分析

目的:探讨双侧唇裂术后复裂的原因,以利于提高双侧唇裂的整复效果.方法:选择采用格洛弗式法经治的412例双侧唇裂术后复裂的患儿38例,对其复裂前的临床表现、复裂的时间特点及全身和局部情况进行分析.结果:完全性、混合性等严重复裂,复裂前的全身及局部症状较轻,复裂的高峰期在手术后第5、6天.结论:完全性复裂主要原因是松弛减张不彻底;而部分复裂与患儿的全身及局部情况、操作技巧及术前、术中、术后护理密切相关.     

Epidemiology underpinning research in the aetiology of orofacial clefts

INTRODUCTION: Epidemiological information gathered through birth defects surveillance is an important adjunct to carrying out clinical and aetiological research. Information on the incidence in the population, causative risk factors and providing baseline data prior to intervention are all important elements. Under the auspices of the World Health Organisation, it was agreed that a global registry and database on craniofacial anomalies should be created and this, the International Database on Craniofacial Anomalies (ICDFA) was designed to gather information on craniofacial abnormalities from existing birth defects registries and databases around the world to become a resource underpinning research. There are currently 62 registries covering 2 million births per year contributing to a database along with information on the size and type of studies used to collect the information, any variation in ascertainment and on the inclusion of syndromes and associated abnormalities. GENERATION OF HYPOTHESES: From the epidemiological data collected it is possible to carry out meta-analysis and to search for trends and consistencies in the data that enable hypothesis to be generated. Issues such as geographical distribution, ethnicity, gender, associated abnormalities and clefts in stillbirths can all be examined in a meta-analytical approach. Collection of information on risk factors such as maternal illnesses, medications, lifestyle factors, nutrition and perhaps occupational exposures enables investigation into environmental contribution to causality and genetic predisposition. A range of techniques are currently being used to identify new candidate genes and ultimately it will be necessary to test genetic and environmental hypothesis in the context of human population studies. CONCLUSIONS: It is only by consistency of association between different populations with different gene pools and maternal exposures, lifestyles, nutrition etc that conclusive evidence regarding causality will be found. It is therefore essential, and a major objective of the WHO that international multicentre collaborative studies are setup to gather the appropriate evidence and improve knowledge and the cause of birth defects in general and orofacial clefts in particular, with the ultimate humanitarian and scientific objective of the WHO being primary prevention. CLINICAL UTILITY AND IMPLICATIONS: This IDCFA project fulfils three basic objectives namely to enable global surveillance of CFA; to create online access to those who wish to contribute to the IDCFA, and to develop an online directory of resources on craniofacial anomalies for the support of research and improving quality of care. The next steps for IPDTOC are to expand the number of participating registries and to actively collect data on other craniofacial birth defects.     

单侧隐性唇裂整复方法的研究

目的：探讨单侧隐性唇裂的修复方法及疗效。方法：对25例单侧隐性唇裂患者采用改良唇裂修复术进行手术治疗,C瓣中的肌肉向外旋转与鼻翼基底的口轮匝肌缝合,为了恢复唇弓的对称性,患侧唇峰上方设计三角形皮瓣。结果：25例患者中,伤口均Ⅰ期愈合,术后唇弓和上唇的形态恢复良好,患侧人中嵴较明显,鼻畸形得到明显改善。结论：改良唇裂修复术治疗单侧隐性唇裂可以有效地恢复上唇的对称性和丰满度。     

Survey of state funds available for rehabilitation of patients with cleft lip/palate

An effort was made to determine the amount of funds budgeted in each of the 50 U.S. states for total rehabilitation of patients with cleft lip and/or cleft palate. Questionnaires were sent following a pilot letter to the directors of each state Department of Health. Total funds per patient ranged from $17,442 for Delaware to a low of $426 for Wisconsin. Dental funds per patient ranged from $4,214 dollars for Wyoming to a low of $192 for New York.     

101例新生儿唇腭裂临床统计与病因分析

1961年1月1日～1995年12月30日,在武汉市第二医院住院分娩97685例活产新生儿中共检出唇腭裂101例,唇腭裂发生率为1.03‰,其中,唇裂占37.62％,腭裂18.81％,唇裂伴腭裂43.57％。统计学分析发现在不同胎次和不同新生儿体重组别中,唇腭裂的发生率有显著性差异(P<0.01)。推测唇腭裂畸形的发生与母体分娩过多,生殖机能减退,生殖器官衰老及胎儿的营养状况有一定关系。     

唇裂或唇腭裂术后继发畸形二期整复后的并发症及预防

本文对唇裂或唇腭裂术后继发畸形二期整复后并发症产生的可能原因及预防措施进行了分析和评述,以期总结经验,减少并发症的发生。     

Clefts of the lip and palate: is the Internet a trustworthy source of information for patients?

Great numbers of patients use the Internet to obtain information and familiarize themselves with medical conditions. However, the quality of Internet-based information on clefts of the lip and palate has not yet been examined. The goal of this study was to assess the quality of Internet-based patient information on orofacial clefts. Websites were evaluated based on the modified Ensuring Quality Information for Patients (EQIP) instrument (36 items). Three hundred websites were identified using the most popular search engines. Of these, 146 were assessed after the exclusion of duplicates, irrelevant sites, and web pages in languages other than English. Thirty-four (23.2%) web pages, designed mostly by academic centres and hospitals, covered more than 22 items and were classified as high-score websites. The EQIP score achieved by websites ranged between 4 and 30, out of a total possible 36 points; the median score was 19 points. The top five high-scoring web pages are highlighted. The overall quality of Internet-based patient information on orofacial clefts is low. Also, the majority of web pages created by medical practitioners have a marketing perspective and in order to attract more patients/customers avoid mentioning the risks of the reconstructive procedures needed.